National Audit Office Report

The National Audit Office, in a recent study that follows up a 1996 report, states that the NHS is still struggling to improve the health and safety of its staff despite numerous high profile health and safety initiatives in the past five years. The study concludes that, while improvements are being made in managing risks, progress overall is patchy, and the gap between the best and worst performing trusts is widening.

Initiatives have included a national healthy workplace campaign, guidance to improve understanding of the legal framework and encourage best practice, and targeting back pain and violence.

Unfortunately, the target of a 20% reduction in accidents and ill health was met by only 23% of respondents, while 64% reported an increase. Overall, the number of incidents rose by 24% between 2000/01 and 2001/02, and violence and aggressive incidents rose by 13%. In each trust surveyed, the rate of accidents per 1,000 staff increased, with ambulance trusts consistently recording the highest accident rates.

NHS sickness absence rates are also well above average (4.9% compared to 3.7% in the rest of the public sector) and, combined with the above, the report estimates the direct cost of staff accidents to be over £173m pa.

Some trusts have seen decreases due to good working practices and improved risk management, whilst others have seen a rise due to better reporting procedures and awareness. One in five cited staff shortages and increased workload as a factor behind the increases, others highlighted improved reporting, increased bed numbers and poor working practices. Factors identified as reducing incidents include clearer policies and procedures, staff training, employment of specialists and improvements in equipment.

Most trusts now comply with DH guidance for managing health and safety risks, for example:

Almost all trusts have appointed a board member with specific responsibility for health and safety, 71% discuss health and safety at board level at least six-monthly, but 12% never discuss it at board level

Almost all trusts have a separate health and safety committee with staff representation that meets six-monthly

80% of trust chief executives have reviewed their health and safety arrangements in the past year

98% of trusts have a written policy on general health and safety management and the other 2% are drafting one, although surveys show that many staff are unaware of these policies

90% have a risk assessment policy and 95% have appointed a competent person to lead on health and safety matters.

The report notes the progress but points out, given the inconsistencies revealed by its investigation, that uniform health and safety induction programmes and refresher training could help alleviate the problem, although workloads and staff shortages are seen as barriers to staff attending training, with doctors the least likely to attend. Trusts are urged to address this.

The report also found that all trusts now offer staff occupational health services, but again provision varies in quality and accessibility with approx 75% of trusts identifying resource constraints as the problem. Provision varies between a single part time nurse to a dedicated team of doctors, nurses and support staff. 82% of trusts have in- house staff, whilst only 30% mental health trusts and 17% of ambulance trusts do so.

All trust occupational health departments say they provide access to counselling services and the DH recommends that trusts review their practices to ensure they are pro-active and cover such issues as stress and rehabilitation.

The report also establishes that only 31% of trusts are proactive in ensuring contractors' safety and it urges the DH to remind trusts of their responsibilities to all staff on their sites and to review their systems in this regard.

In 1996 the absence of robust reporting systems was criticised. Today all trusts claim to have improved their procedures, encourage staff to report incidents and provide training. However, under-reporting remains significant, and there is a discrepancy between what trusts believe to be reportable. The report therefore calls for a consistent approach to recording and measures to tackle under reporting that draw on best practise. A clear unambiguous reporting structure throughout the NHS is the aim.

Finally, the report recommends:

That the DoH should consider the development of a national health and safety strategy to coordinate existing and new initiatives

That all trusts should review their policies to reflect the views of staff

That all trusts examine the extent to which clinical and non clinical risk assessments could be integrated

The head of the NAO states that although more needs to be done to reduce accidents, some good progress has been made despite widespread variations in provision. He also states that counselling and support help staff to get back to work more quickly, and this may assist in recruitment and retention. He adds “the NHS must show that the health and safety of its staff is a top priority.”

We agree with him: health and safety is paramount for RCM members. We note that the report implies that more can be done to raise health and safety standards in the workplace.

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